CDI Validation Specialist Compunnel, Inc.CDI Validation SpecialistBoston, Massachusetts$63 / hourTemporaryFull timeThis role ensures efficiency, accuracy, and quality of documentation, supports education and training for CDI Specialists, and collaborates with coding and validation managers to improve documentation practices that directly impact key performance indicators. Job Summary We are seeking an experienced CDI Validation Specialist (CDI Team Lead) to oversee, evaluate, and analyze Clinical Documentation Integrity (CDI) functions.
FS Java Angular v16+ AWS API Kforce Inc.FS Java Angular v16+ AWS APIBoston, MA$64–$74Use of formal methods (traditional structured or Agile/iterative) for delivering new or enhanced applications, identify and communicating systems development processes and developing work you're doing associated with the respective phases of the lifecycle. 4+ years of proven experience with server-side development with Java, Spring, Spring Boot, Camel, JMS, Apache Kafka, and Persistence frameworks (JPA/Hibernate).
Coding Compliance Analyst UnitedHealth Group IncCoding Compliance AnalystWorcester, MARemote$23.89–$42.69 / hourThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Conducts random and scheduled internal audits of physician billing and medical records documentation to ensure: Correct Coding (CPT, ICD-10, HCPCS, Modifiers), Accurate Data Entry, Accurate Charge Preparation/Processing, Compliance with governmental and third-party billing regulations.
Technical Product Owner - AI Coding Platforms Boston Scientific CorpTechnical Product Owner - AI Coding PlatformsMarlborough, MAServe as the primary product interface with external AI partners, including vendors such as OpenAI, Anthropic and other strategic providers, to manage joint roadmaps, influence feature direction, resolve enterprise adoption barriers and accelerate the rollout of AI coding capabilities at Boston Scientific. This role will own the portfolio of AI coding capabilities that support engineers, data scientists, researchers and technical teams in using AI assistants, coding agents, large language model-powered developer tools and workflow automation safely and effectively within enterprise guardrails.
NewCoding Specialist III C999 UMass Memorial Health CareCoding Specialist IIIWorcester, MAJob Description We are seeking a qualified Medical Coding Specialist to interpret medical record data, assign ICD‑CM, CPT codes and modifiers, manage coding staff and workflows, and ensure coding quality and compliance. Qualifications High School education, plus recognized medical coding certification and training in medical terminology from an accredited program (AHIMA, NHA, AAPC).Certified CPC and experience in IR coding.
Coding Specialist III UMass Memorial HealthCoding Specialist IIIWorcester, MassachusettsExceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. Requires good interpersonal and communications skills and maintains a professional manner when working with team members, management and other staff members.
Scratch & Intro to Coding Teaching Opportunities Concorde EducationScratch & Intro to Coding Teaching OpportunitiesBoston, Massachusetts$50–$100 / hourSome programs provide established lesson plans and project guides, while others allow instructors flexibility to incorporate age-appropriate coding activities and creative projects that align with assignment objectives and school expectations. Assignment offers remain contingent upon factors including program availability, instructor qualifications, school partner approval, scheduling compatibility, successful completion of any legally required background review or clearance process, and final written assignment confirmation.
Coding Specialist II, Professional Billing UMass Memorial Health Care IncCoding Specialist II, Professional BillingWorcester, MA$23.81–$35.08 / hourExceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. Individual Departments, (Emergency Medicine, Trauma Center, Endoscopy Suite, PBCBO, HIM, etc.) will have unique procedures, processes and/or focus, so responsibilities and tasks can differ depending on departmental needs.
NewCoding Specialist II, Professional Billing UMass Memorial HealthCoding Specialist II, Professional BillingWorcester, MassachusettsExceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. Individual Departments, (Emergency Medicine, Trauma Center, Endoscopy Suite, PBCBO, HIM, etc.) will have unique procedures, processes and/or focus, so responsibilities and tasks can differ depending on departmental needs.
Coding & Compliance Manager, Surgery Lahey Hospital and Medical CenterCoding & Compliance Manager, SurgeryBoston, MA$92,955–$125,091 / yearMay perform additional job duties as time permits, such as: developing and presenting performance metric reports with a review of findings with Attending Physicians, Directors, Managers and Chiefs; service on committees; maintains relationship with third party billing companies to ensure continuous excellence in services; fosters relationships with affiliates related to coding and compliance. Monitors, proposes, and minimizes billing and coding operational inefficiencies by reviewing accuracy and production levels and communicating data analysis on audit trends, scrubber data, government audit requests, denials/appeals as well as developing and implementing corrective action plans for setting performance targets.
NewCoding Specialist III, Professional Billing UMass Memorial Health Care IncCoding Specialist III, Professional BillingWorcester, MA$25.83–$38.36 / hourExceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. Requires good interpersonal and communications skills and maintains a professional manner when working with team members, management and other staff members.
NewCoding Specialist III, Professional Billing UMass Memorial HealthCoding Specialist III, Professional BillingWorcester, MassachusettsExceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. 4. Requires good interpersonal and communications skills and maintains a professional manner when working with team members, management and other staff members.
Coding Specialist Outpatient Telecommute-Surgical Coder Brown University HealthCoding Specialist Outpatient Telecommute-Surgical CoderRI$24.29–$40.07 / hourMonitors and resolves rejected accounts on the Claims Edit Report and e Clinical Works error reports by established timeframe researching coding conflicts including chargemaster, medical necessity and various other coding and billing issues. Reviews the outpatient clinical documentation of extract data and assign appropriate ICD-10-CM and CPT codes in accordance with the outpatient ICD-10-CM Official Guidelines for Coding and Reporting and the AHA HCPCS Coding Clinics.
NewCoding and Compliance Auditor South Shore HealthCoding and Compliance AuditorBoston, MAThe Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders. Support all departments of the Health System with coding guidance: Pertaining to compliance training / education as requested from providers and/or staff related to coding, billing and documentation in the inpatient, outpatient, professional, surgical and Home Health divisions of the Health System to ensure accuracy and support program objectives.
Medical Coding Educator & Auditor StratAcuity Staffing Partners IncMedical Coding Educator & AuditorMARemote$65,000–$75,000 / yearIn terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. This highly visible role supports more than 400 physicians across multiple specialties and requires a unique blend of advanced coding expertise, audit experience, and the ability to confidently educate and present to both small groups and large physician audiences.
SIU Code Auditor Fallon HealthSIU Code AuditorWorcester, MassachusettsThe SIU Code Auditor will conduct coding audits of medical records provided by providers to check for missing documentation and other medical documentation for E&M, DME, medical, home health services, and may include some behavioral health care services to identify potential over-payments and suspected fraud waste and abuse. Reporting, education, and regulatory support: Assist with claim denial reporting, respond to regulatory agency complaints, support required fraud reporting to state and federal agencies, and recommend to members, providers, or employee education based on findings.
Coding & Compliance Auditor South Shore Health Systems IncCoding & Compliance AuditorWeymouth, MA$73,000–$104,400 / yearResponsibilities if Required: Education if Required: License/Registration/Certification Requirements: Certified Coding Associate - American Health Information Management Association (AHIMA), Certified Coding Specialist - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physician Based - American Health Information Management Association (AHIMA), Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Certified Professional Medical Auditor (CPMA) - American Academy of Professional Coders (AAPC), Registered Health Information Administrator - American Health Information Management Association (AHIMA). The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders.
SIU Code Auditor Fallon Community Health Plan IncSIU Code AuditorWorcester, MABrief summary of purpose: The SIU Code Auditor will conduct coding audits of medical records provided by providers to check for missing documentation and other medical documentation for E&M, DME, medical, home health services, and may include some behavioral health care services to identify potential over-payments and suspected fraud waste and abuse. Reporting, education, and regulatory support: Assist with claim denial reporting, respond to regulatory agency complaints, support required fraud reporting to state and federal agencies, and recommend to members, providers, or employee education based on findings.
Epic Resolute Application Developer (Charge Router and Coding Skills) - 6260321 Accenture PlcEpic Resolute Application Developer (Charge Router and Coding Skills) - 6260321Boston, MAIn addition to delivering innovative solutions for Accenture's clients, you will work with a highly skilled, diverse network of people across Accenture businesses who are using the latest emerging technologies to address today's biggest business challenges. Dropping orders using chart review-> creating new patient encounter -> dropping an order and signing the order/Unite charge entry ->creating new encounter.
Manager Professional Billing Coding Operations - Remote Boston Medical CenterManager Professional Billing Coding Operations - RemoteMARemote$78,000–$113,000 / yearThe hospital is also the primary teaching affiliate of the nationally ranked Boston University School of Medicine (BUSM) and a founding partner of Boston HealthNet - an integrated health care delivery systems that includes many community health centers. Provides training to healthcare professionals, coders, and Revenue Cycle staff in ICD, CPT, HCPCS Level II coding guidelines, proper documentation guidelines and other information related to coding.
Ambulatory Coding Lead Signature HealthcareAmbulatory Coding LeadWest Bridgewater, MAResponsible for insuring accurate diagnosis and procedure coding as well as providing documentation and coding related feedback and educational services to providers and coders. Monitors coding productivity and assigns/prioritizes daily work schedules for Coding Specialists, Risk Coders and charge entry staff.
Lead Coding Instructor Code NinjasLead Coding InstructorCanto, MassachusettsWe are looking for a Lead Coding Instructor to join our team of dynamic, energetic, forward-thinking minds, working toward our common goal: providing a fun and safe learning environment for children. Growth Opportunities: Code Ninjas is a rapidly growing organization, and strong team members have opportunities for career progression into leadership and management roles within the center.
Coding Instructor Home HelpersCoding InstructorAarlington, MassachusettsWe recognize our direct care staff as our greatest asset and offer: competitive compensation, initial & ongoing training, flexible hours, and a FRIENDLY & SUPPORTIVE WORK ATMOSPHERE. As part of our school outreach program, we offer classes in all surrounding public school districts of Acton, Westford, Concord, Lexington, Arlington, Bedford, Burlington and Belmont areas.
Coding Instructor Code NinjasCoding InstructorHopkinton, MassachusettsWe are looking for a Coding Instructor to join our team of dynamic, energetic, forward-thinking minds, working toward our common goal: providing a fun and safe learning environment for children. Parents are thrilled as their children gain confidence and new skills including coding, math, logic, and problem-solving, as they progress from white to black belt.
Coding Instructor Home Helpers of South ShoreCoding InstructorBelmont, MA, MAAs part of our school outreach program, we offer classes in all surrounding public school districts of Acton, Westford, Concord, Lexington, Arlington, Bedford, Burlington and Belmont areas. An ideal candidate for this position will be someone who has completed or currently pursuing undergraduate/graduate in Computer Science or similar STEM related fields.
NewAI Pilot Vibe Coding Specialist Mind RiftAI Pilot Vibe Coding SpecialistProvidence, RIRemoteBachelor's or Master's Degree in Engineering, Applied Mathematics, Computer Science, or related technical fields is a plusPython web scraping: Build reliable scraping scripts using BeautifulSoup, Selenium (or equivalents) for multi-level sites, dynamic JS content (infinite scroll, AJAX), and API endpoints via provided proxyData extraction expertise: Navigate complex hierarchical structures (regions companies details), handling archived pages and varied HTML formatsData processing: Clean, normalize, and validate scraped data; deliver high-quality datasets in well-structured formats (CSV, JSON, Google Sheets) with clear, consistent presentationHands‑on experience with LLMs and AI frameworks to enhance automation and problem‑solvingStrong attention to detail and commitment to data accuracySelf‑directed work ethic with ability to troubleshoot independentlyEnglish proficiency: Upper‑intermediate (B2) or above (required)BenefitsGet paid for your expertise, with rates that can go up to $32/hour depending on your skills, experience, and project needsWork fully remote on your own schedule with just a laptop and stable internet connection. As a Vibe Code specialist, you'll handle data scraping tasks requiring technical precision for web extraction and processing, utilizing various tools such as our provided Apify and OpenRouter alongside your own resourceful approaches.
STEM & Coding Teaching Opportunities Concorde EducationSTEM & Coding Teaching OpportunitiesBoston, Massachusetts$50–$100 / hourPreferred qualifications include: • At least 60 college credits, where required by the applicable assignment or site; • Experience with coding, programming, computer science, or related technology subjects; • Experience teaching, tutoring, coaching, mentoring, or leading activities with school-age students; • Strong communication, organization, and classroom facilitation skills; • Availability to provide services for the accepted assignment schedule and communicate schedule issues as soon as reasonably practicable; and. Payment for completed services is generally made by direct deposit on the fifteenth day of the month following the month in which services were completed, unless otherwise stated in the accepted assignment terms or required by applicable law.
No-Code Business Analyst Creatio EMEA LTDNo-Code Business AnalystBoston, MAVersion Control: Utilize Git/SVN for version control, ensuring seamless collaboration, code integrity, and efficient management of application changesRequired Skills & Competencies:Proven experience in conducting business analysis and research tasks, including market research, competitor analysis, and gathering business requirements to shape product features. Web Services Integration: Create web services for system integration using no-code tools, including designing RESTful APIs and SOAP interfaces to enable seamless data exchange, ensuring adherence to security protocols, and providing documentation for developers and third-party systems.
NewSenior/Principal Code Consultant RimkusSenior/Principal Code ConsultantBoston, MAEmployee is frequently required to stand, walk on slope roofs, sit, climb ladders, work from stationary and moveable scaffolding (aka swing stages), bend, climb inside attics and crawl under homes and tunnels, balance, stoop, kneel, crouch, talk, hear, and drive a motor vehicle to job sites. Consulting services include; but are not limited too; providing code analysis and interpretation via email, phone call, and in-person or remote meetings; drafting memos to address code issues; meeting with local officials and fire departments on the client’s behalf; and supporting the in-house engineering and design teams.
General Practice Care - Lead Veterinarian - Swansea , {State_Code UsvtaGeneral Practice Care - Lead Veterinarian - Swansea , {State_CodeSwansea, MassachusettsAn exceptional veterinary hospital, with a dedicated team, is seeking an experienced Lead Veterinarian to provide clinical leadership, oversee day -to -day medical operations, and ensure superior patient and client care to members of its community. This hospital is open to considering experienced veterinarians who are prepared to take on a senior clinical leadership role, overseeing team performance and working collaboratively with the practice manager and medical director.
General Practice Care - Associate Veterinarian - North Kingstown , {State_Code UsvtaGeneral Practice Care - Associate Veterinarian - North Kingstown , {State_CodeNorth Kingstown, Rhode IslandAn exceptional veterinary hospital, with a dedicated team, is seeking an Associate Veterinarian to provide superior patient and client care to members of its community. of rewards and benefits that our partners may offer, but the specific details surrounding each hospital’s total rewards package will be provided by the hiring manager during each interview process.
Emergency Care - Associate Veterinarian - Swansea , {State_Code UsvtaEmergency Care - Associate Veterinarian - Swansea , {State_CodeSwansea, MassachusettsAn exceptional veterinary hospital, with a dedicated team, is seeking an Associate Veterinarian to provide superior patient and client care to members of its community. The ideal team member for this hospital is a veterinarian who thrives in high -volume environments and remains calm and levelheaded under pressure!
General Practice Care - Associate Veterinarian - Swansea , {State_Code UsvtaGeneral Practice Care - Associate Veterinarian - Swansea , {State_CodeSwansea, MassachusettsAn exceptional veterinary hospital, with a dedicated team, is seeking an Associate Veterinarian to provide superior patient and client care to members of its community. of rewards and benefits that our partners may offer, but the specific details surrounding each hospital’s total rewards package will be provided by the hiring manager during each interview process.
NewRemote AI Systems Engineer & Code Trainer DataAnnotationRemote AI Systems Engineer & Code TrainerBoston, MARemoteIdeal candidates are fluent in English, proficient in various programming languages, and have strong writing skills. You will design coding problems, write high-quality code, and evaluate AI-generated content.
NewRemote AI Training Engineer - Code & Train Models DataAnnotationRemote AI Training Engineer - Code & Train ModelsProvidence, RIRemoteA leading AI development company is seeking proficient programmers to contribute to cutting-edge AI systems while enjoying fully remote work opportunities. Candidates should have fluency in English and preferred experience in Kotlin, along with strong skills in other programming languages.
Plumbing, Mechanical, and Energy Code Inspector (Closed) City of East ProvidencePlumbing, Mechanical, and Energy Code Inspector (Closed)East Providence, RISummary: Under the general supervision of the Building Official, the Plumbing Mechanical and Energy Code Inspector performs technical work inspecting plumbing and mechanical installations for conformity with BOCA Basic Plumbing Code, BOCA Basic Mechanical Code, State regulations, and City Ordinances. • Knowledge of warm air heating, ventilating, and air conditioning systems, steam and hot water heating systems, boiler and pressure vessel maintenance and inspection, mechanical, refrigeration, gas, liquid, and solid fuel piping and equipment, and air pollution control equipment.
Administrative Assistant-Medical Billing Providence Comprehensive Treatment CenterAdministrative Assistant-Medical BillingProvidence, Rhode Island$19.66–$22.61 / hourFull timeProvidence Comprehensive Treatment Center (CTC), located in Providence, RI, is part of Acadia Healthcare's Comprehensive Treatment Centers—the nation's leader in medication-assisted treatment (MAT) for individuals seeking recovery from Opioid Use Disorder. Familiarity with MAT Protocols and Guidelines: The billing specialist should understand how Medication-Assisted Treatment works, including services like opioid substitution therapy (e.g., methadone, buprenorphine) and how these treatments are billed differently from other medical services.
Administrative Assistant-Medical Billing Acadia Healthcare Co IncAdministrative Assistant-Medical BillingProvidence, RI$19.66–$22.61 / hourOur Team: Providence Comprehensive Treatment Center (CTC), located in Providence, RI, is part of Acadia Healthcare''s Comprehensive Treatment Centers-the nation''s leader in medication-assisted treatment (MAT) for individuals seeking recovery from Opioid Use Disorder. Your Job as an Administrative Support/Medical Biller: The Administrative Support/Medical Biller role will perform routine administrative functions such as preparing correspondence and reports, scheduling appointments, organizing and maintaining paper and electronic files, or providing information to patients or visitors.
Experienced Medical Billing Coordinator - Part Time Evolve Chiropractic & WellnessExperienced Medical Billing Coordinator - Part TimeBoston, MAWe are looking for someone with knowledge of PIP insurance billing, verifications, authorizations, obtaining referrals, and collecting money. Evolve is looking for an experienced Medical Billing Coordinator to join our dynamic team!
Billing Compliance Reviewer Dana-Farber Cancer Institute IncBilling Compliance ReviewerBROOKLINE, MARemote$84,000–$91,300 / yearPartner with clinical providers, coding/HIM, revenue integrity, pharmacy, nursing, research billing, and practice operations to remediate findings, implement internal controls, and monitor corrective actions; track effectiveness of remediation through defined metrics. Reporting to the Director of Billing Compliance, the Billing Compliance Reviewer plans and executes risk-based audits, analyzes documentation and coding for medical necessity and regulatory adherence, and recommends corrective actions to mitigate compliance risk.
Medical Billing / Claims Administrator Ametros FinancialMedical Billing / Claims AdministratorMassachusettsHandle inbound and outbound calls, emails, and chats related to claims, coverage guidelines, and provider inquiries providing expert-level support and guidance to a wide variety of audiences. The Claims Specialist plays a critical role in the end-to-end management of member claims, ensuring accuracy, timeliness, and compliance across all claim-related activities.
Director Billing Compliance Dana-Farber Cancer Institute IncDirector Billing ComplianceBROOKLINE, MARemote$154,200–$170,800 / yearResponsibilities include leading routine monitoring, assessing for and identifying areas of risk assessments, conducting investigations, responding to audits, providing consultation/guidance, and sharing program findings with providers and leadership. Reporting to the VP, Chief Compliance Officer with a dotted line reporting relationship to the VP, Revenue Performance Management, the Director of Billing Compliance is a strategic leader and subject matter expert responsible for ensuring the integrity, accuracy, and compliance of billing practices across the organization.
Sr Billing Specialist RIH Rhode Island HospitalSr Billing SpecialistRhode IslandMust use and have knowledge of courteous telephone technique and good customer service skills.p class=MsoBodyText margin-top:0inp class=MsoBodyText margin-top:0inThe interpersonal skills to exchange factual information with patients and outside agencies with cultural sensitivity and professionalism.p class=MsoBodyText margin-top:0inp class=MsoBodyText margin-top:0inEXPERIENCE:p class=MsoBodyText margin-top:0inp class=MsoBodyText margin-top:0inTwo years’ related experience coding and billing using dental billing software and demonstrated expertise and accuracy of code assignment. Training in CDT coding, anatomy, physiology, and dental terminology.p class=MsoBodyText margin-top:0inp class=MsoBodyText margin-top:0inExperience with Dental software, preferably Dentrix.p class=MsoBodyText margin-top:0inp class=MsoBodyText margin-top:0inDemonstrated knowledge of PC skills using the windows operating system environment and accompanying software packages.
Medical Coder II/III CodaMetrixMedical Coder II/IIIBoston, MassachusettsThis role requires a proven ability to communicate highly complex coding issues and solutions to a wide range of stakeholders, alongside an unwavering commitment to continuous learning, quality, and innovation in medical coding practices. They will play a pivotal role in improving the quality and efficiency of coding operations by collaborating closely with cross-functional teams, including Machine Learning, Product, and Customer Implementations.
Hospital Billing Coordinator Deloitte Touche Tohmatsu LtdHospital Billing CoordinatorMA$50,000–$60,000 / yearOur purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. This compensation range is specific to the remote role and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
Sr Billing Specialist Brown University HealthSr Billing SpecialistProvidence, RI$22.04–$36.37 / hourMust use and have knowledge of courteous telephone technique and good customer service skills.p class=MsoBodyText margin-top:0inp class=MsoBodyText margin-top:0inThe interpersonal skills to exchange factual information with patients and outside agencies with cultural sensitivity and professionalism.p class=MsoBodyText margin-top:0inp class=MsoBodyText margin-top:0inEXPERIENCE:p class=MsoBodyText margin-top:0inp class=MsoBodyText margin-top:0inTwo years' related experience coding and billing using dental billing software and demonstrated expertise and accuracy of code assignment. Training in CDT coding, anatomy, physiology, and dental terminology.p class=MsoBodyText margin-top:0inp class=MsoBodyText margin-top:0inExperience with Dental software, preferably Dentrix.p class=MsoBodyText margin-top:0inp class=MsoBodyText margin-top:0inDemonstrated knowledge of PC skills using the windows operating system environment and accompanying software packages.
Clinical Audit Response Specialist Dana-Farber Cancer Institute IncClinical Audit Response SpecialistBOSTON, MARemoteReporting to the Director of Patient Financial Services, the Revenue Protection Specialist is responsible for managing and responding to external audits from government and commercial insurance companies, as well as interpreting evolving payer policies to safeguard the Institutes revenue. The Revenue Protection Specialist will utilize their clinical expertise and knowledge of billing practices to address audit findings, interpret payer policies, prepare detailed responses, and implement corrective actions to enhance compliance and revenue integrity.
Outpatient Services Rep RIH Rhode Island HospitalOutpatient Services RepRhode IslandBrown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. Evaluates file prior to schedule visit and follows up with other Hospital departments to obtain missing data Prints reports using both the online scheduling and billing systems.
Inpatient DRG Reviewer Zelis Healthcare, Inc.Inpatient DRG ReviewerBoston, MA$79,000–$99,750 / yearRN or LVN required • Inpatient Coding Certification required (CCS, CIC) within 4 - 6 months of hire date • 1 -3 years reviewing and or auditing ICD-10 CM, MS-DRG and APPR-DRG claims preferred • Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs • Experience performing readmission reviews, including evaluating relatedness, preventability, and compliance with readmission policies • Understanding of hospital coding and billing rules • Clinical skills to evaluate appropriate Medical Record Coding • Experience conducting root cause analysis and identifying solutions • Strong organization skills with attention to detail • Outstanding verbal and written communication skills. • Using the revised codes, regroup the claim using provided software to determine the 'new DRG' • Where the regrouped 'new DRG' differs from what was originally claimed by the provider, write a customer facing 'rationale' or 'findings' statement, highlighting the problems found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review • Document all aspects of audits including uploading all provider communications, clinical rationale, and/or financial research • Identify new DRG coding concepts to expand the DRG product.
Senior Consultant - Clinical Documentation Specialist Deloitte Touche Tohmatsu LtdSenior Consultant - Clinical Documentation SpecialistMA$110,700–$218,300 / yearOther skills include the ability to analyze, act and design action plans upon monthly and quarterly reports related to individual providers, facilities, MS-DRGs, APR, PSIs, severity of illness and risk of mortality, capture rates, quality metrics and can effectively prioritize their work activities. Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory, clinical based evidence and contractual requirements while also determining that payments are appropriate for the type and level of care provided.